A Pediatricians' Raw Experience in Private Independent Medical Practice on the front lines.

Wednesday, July 20, 2016

Going Rogue

Historically, the word Rogue
was a descriptive term for elephants behaving in a dangerous way, often
when injured or experiencing separation from the herd. The expression
today refers to a person who is displaying independence or failing to follow an
expected script. As the reality of MACRA (Medicare Access and CHIP
Reauthorization Act of 2015) looms, the pressure is on small practices to
survive. CMS plans to penalize 87% of solo physicians and reward bonuses
to 81% of practices with more than 100 physicians. It is time for passive
resistance, defined as protesting against a law using peaceful methods such as
refusing to obey or refusing to leave a building. I am vehemently
refusing to leave the building.

We are entering the era of Big
Box medicine; where prices are cheap and quality will be questionable.
CMS will favor physicians at larger conglomerates because they will be
able to keep up with overwhelming data reporting demands. I do not agree
that mountains of data are essential to providing high quality care.
Physicians are not in charge of our destiny. What if we could
be? What if we buck the status quo and refuse to comply?

As of yesterday morning, mine
is the last pediatric practice accepting Medicaid patients who are not newborns
in my hometown. In my county, 50% of the children are on Medicaid.
We have 3 fewer pediatricians than we did five years ago. For a
population of 260,000, 16 pediatricians remain. Two of those currently
practicing (including my father) are more than 80 years old. Patients
wait for months on our waitlist. They are THRILLED to get in.
Sometimes I cannot believe how excited they are to walk through our door.
There are simply not enough of us to go around. If this continues,
children will not have access to a pediatrician when they need it. Five
years ago, I accepted 20 new patients per month. Today, I accepted 10 and
put 7 on the waiting list. In ONE day. The call volume is
unbelievable. This is our future if we do nothing.

The health disparity seen in my
office every day is abominable; the need for basic care vast. A nine month old
baby pulled off my waitlist after 4 months had eczema so severe he looked like
a burn victim. The thought of children not receiving necessary
medical care so they can properly grow, develop, and thrive keeps me awake at
night. Our survival is paramount.

Which brings me to my point.

I am going rogue. Market
forces are on my side. Physicians have a right to make a living. A
little civil disobedience is in order. We need to stop following the
guidelines and care for patients in spite of a system actively working against
us. If CMS leverages a penalty, I will need my Medicaid patients to pay
that amount as an out-of-pocket fee; because it will keep my doors open.
I need to stay in business. I must pay my staff, buy supplies, and pay
rent. I have four small children and a mortgage. Those are standard
life obligations.

Small
practices have lower readmission rates and know
their patients better than larger health care conglomerates. I know my
patients. I know their parents. Heck, I even know their
grandparents. I am exceptionally effective at keeping children out of the
hospital. My patients prefer my office to the local urgent care or
emergency room. If you wake up and your child is unexpectedly ill, you
can walk in and be seen the same day. If your child splits their head
open at school, bring them down and I will stitch them up. You might have
to wait a bit, but the delay is less than at the local ER. I provide
excellent quality and service.

I know my families can afford
$3 per visit. I know they will be willing to pay it. They already
pay out of pocket for no-shows, typed letters, and FMLA paperwork. They
pay out of pocket for photocopies and after-hours nurse calls. CMS Table
64 shows there are 102,788 solo practices and 123,695 practices with 2-9
physicians. Can the government really go after almost a quarter million
medical practices for disobeying the rules?

Abraham Lincoln said,
“Government of the people, by the people, and for the people, shall not perish
from the Earth.” The decision of who provides good quality care should be
in the hands of the people, not the government. The people can vote with
their feet and their pocketbooks, paying a small amount to make up for this
outrageous government blunder. Otherwise, many valuable small
practices will close their doors.

Primary care physicians are the
backbone of the health care system in this country. A “CMS co-pay” in
response to the $3- $9 per visit penalty is the best way to prevent our
livelihoods from being destroyed. We must stop being afraid.
We know health care. We know our patients. We trust in our
abilities to save lives. Physicians in solo and small practices will not
perish if we let the people decide in whose hands they place their trust.
It is time to be mavericks. If we work together, stop blindly following
along, and put ourselves back in control of our healthcare system, we can
passively resist until something changes. Our health, Our people.
It is time to go rogue.

1 comment:

I am a solo practice owner and the only internist left in our area for the past 18 years. I have no inheritance but I have found a way to double my income and helped my patients to stay healthy and avoid admission! I love to share with physicians who want to do the same.